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...uIIvI <br />Vll -�7IGC L R1NUU <br />CM11 <br />r��y <br />&4 te,,, . <br />/ <br />//f0M1 <br />;v <br />a 1 ' r <br />y,e,._ <br />14/6 <br />COTTER CORPORATION SAMPLE SUBMITTAL AND TRACKING FORM <br />Sample Submittal : S 25754 <br />C: P.O. Box 1750 <br />Canon City, CO 81215 <br />Sample Loc. /ID No. <br />Delivered By <br />Received By <br />Date Recd. <br />Time Recd. <br />1. Sample Type: Air <br />QAC <br />c'eti ( <br />Sample Date I / /9 Time / 62. S <br />Collected By .664 r✓/) Ce r <br />Field Custodian e 4' 0 T <br />2. Analysis — Test series requested: <br />Water <br />3. Field Data — Preservation: T'` <br />7 oZ <br />6. Invalidating circumstances? If YES initial ( <br />( ) Check if additional attachments. <br />QA Review: <br />Sample valid? YES ( ) NO ( <br />S: P.O. Box 1750 , N: P.O. Box 700 <br />Canon City, CO 81215 Nucla, CO 81424 <br />Lab. No.(s) <br />Date Data Entered <br />Data Entry By <br />Laboratory Destination if not , Cotter: <br />/d et <br />P "..• P.. y Lc— <br />2 3 . S4 / :f (`rte e k �� <br />Vie= r� � Cv V g 0z <br />df " ' " <br />Soil Other (specify): <br />g. 4 s" 2 5 ,, Sedz <br />c f .n,w/ 2. 3 " u S z s rA 1/4f 0, . , 5 <br />/.5 - D <br />4. Date analysis required by (if not Holding Time): <br />5. Special handling conditions or other instructions: <br />) and explain below. <br />COMMENTS — Explanation of noted items: <br />) If NO, explain: <br />Date <br />Page 33 of 38 <br />